Basic Information
| Provider Information | |||||||||
| NPI: | 1164760823 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEVERLY RADIOLOGY MEDICAL GROUP | ||||||||
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| OtherOrganizationName: | VANOWEN ADVANCED IMAGING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15243 VANOWEN ST | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914053605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187826110 | ||||||||
| FaxNumber: | 8187827354 | ||||||||
| Practice Location | |||||||||
| Address1: | 15243 VANOWEN ST | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914053605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187826110 | ||||||||
| FaxNumber: | 8187827354 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2013 | ||||||||
| LastUpdateDate: | 01/30/2013 | ||||||||
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| AuthorizedOfficialLastName: | BERGER | ||||||||
| AuthorizedOfficialFirstName: | HOWARD | ||||||||
| AuthorizedOfficialMiddleName: | G. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO & PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3104452800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | FNP 43686 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.